Form preview

Get the free FINANCIAL AND STATISTICAL REPORT (COST REPORT) FOR LONG-TERM CARE FACILITIES - www2 ...

Get Form
Este documento es un informe financiero y estadístico requerido por el Departamento de Servicios de Atención Médica y Servicios Familiares del Estado de Illinois para las instalaciones de atención
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign financial and statistical report

Edit
Edit your financial and statistical report form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your financial and statistical report form via URL. You can also download, print, or export forms to your preferred cloud storage service.

How to edit financial and statistical report online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
Use the instructions below to start using our professional PDF editor:
1
Create an account. Begin by choosing Start Free Trial and, if you are a new user, establish a profile.
2
Upload a file. Select Add New on your Dashboard and upload a file from your device or import it from the cloud, online, or internal mail. Then click Edit.
3
Edit financial and statistical report. Add and change text, add new objects, move pages, add watermarks and page numbers, and more. Then click Done when you're done editing and go to the Documents tab to merge or split the file. If you want to lock or unlock the file, click the lock or unlock button.
4
Save your file. Choose it from the list of records. Then, shift the pointer to the right toolbar and select one of the several exporting methods: save it in multiple formats, download it as a PDF, email it, or save it to the cloud.
pdfFiller makes working with documents easier than you could ever imagine. Try it for yourself by creating an account!

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out financial and statistical report

Illustration

How to fill out FINANCIAL AND STATISTICAL REPORT (COST REPORT) FOR LONG-TERM CARE FACILITIES

01
Gather all relevant financial documents for the reporting period, including invoices, receipts, and payroll records.
02
Enter total revenue received from patient care services in the appropriate section of the report.
03
List all operating expenses, categorized by type (e.g., salaries, utilities, supplies) and input the amounts in the designated areas.
04
Calculate depreciation on assets and include this figure in the expenses.
05
Ensure that all data is accurate and reflects the reporting period exactly, checking for any discrepancies.
06
Complete the statistical section by entering patient census data, staffing levels, and occupancy rates.
07
Review the report for completeness and accuracy, ensuring all necessary signatures are included.
08
Submit the finished report to the appropriate regulatory body by the specified deadline.

Who needs FINANCIAL AND STATISTICAL REPORT (COST REPORT) FOR LONG-TERM CARE FACILITIES?

01
Long-term care facilities such as nursing homes, assisted living facilities, and rehabilitation centers.
02
Healthcare regulatory agencies that monitor the financial health and adherence to standards of care of these facilities.
03
Accountants and financial analysts working with long-term care facilities to manage budgets and financial planning.
04
Investors and stakeholders interested in the financial performance of long-term care providers.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.0
Satisfied
28 Votes

People Also Ask about

Nursing home costs by state StateShared room per dayPrivate room per day California $322 $400 Colorado $282 $320 Connecticut $453 $499 District of Columbia $345 $34547 more rows • Sep 26, 2023
The Centers for Medicare and Medicaid Services (CMS), a component of the U.S. Department of Health and Human Services (HHS), administers Medicare, Medicaid, the Children's Health Insurance Program (CHIP), the Clinical Laboratory Improvement Amendments (CLIA), and parts of the Affordable Care Act (ACA) ("Obamacare").
How to Create a Cost Report? Creating a cost report requires gathering data from multiple sources such as invoices, contracts, and timesheets. This data should then be organized into categories such as labor costs, materials, and overhead expenses.
Nursing homes and assisted living facilities Nursing homes represent the most expensive long-term care option, with private rooms costing an estimated 10,646 U.S. dollars per month in 2024. Semi-private rooms are slightly more affordable at 9,277 U.S. dollars monthly.
Cost reports are generally prepared by Cost Consultants and sometimes Quantity Surveyors to keep the client informed about the Project Cost. A cost report includes the costs incurred by the time of reporting and all the future costs (Forecast Cost) that is likely to be incurred during the rest of the project.
Each year, Medicare Part A providers must submit an acceptable Medicare Cost Report (MCR) package to their Medicare Administrative Contractor (MAC) for the purposes of determining their Medicare reimbursable cost. The MCR package consists of a variety of cost report materials.
How to Create a Cost Report? Creating a cost report requires gathering data from multiple sources such as invoices, contracts, and timesheets. This data should then be organized into categories such as labor costs, materials, and overhead expenses.
A Medicare Cost Report (MCR) is a financial account submitted from Medicare-certified entities, such as skilled nursing facilities, hospitals or hospices, to a Medicare Administrative Contractor (MAC). Each entity updates its report at the end of its fiscal year, and MCRs publish quarterly.

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

The Financial and Statistical Report (Cost Report) for long-term care facilities is a comprehensive document that outlines the financial performance and statistical data of the facility, including expenses, revenues, and service deliverables.
Long-term care facilities that receive Medicaid or Medicare funding are typically required to file the Financial and Statistical Report (Cost Report) to maintain compliance with federal and state regulations.
To fill out the Financial and Statistical Report, facilities must gather financial data from their accounting systems, including income, expenses, patient days, and other relevant statistics, and input this information into the standardized format required by the reporting authority.
The purpose of the Financial and Statistical Report is to provide a transparent view of the facility's financial health and service provision, ensuring accountability and aiding in the determination of reimbursement rates from Medicaid and Medicare.
Information required in the Financial and Statistical Report includes total revenue, total expenses, patient days, staffing levels, service costs, and other operational statistics critical to evaluating performance and financial sustainability.
Fill out your financial and statistical report online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.